Provider Demographics
NPI:1194027193
Name:ZAMUDIO, DIANNE
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5324
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32793-5324
Mailing Address - Country:US
Mailing Address - Phone:407-860-5475
Mailing Address - Fax:407-672-0866
Practice Address - Street 1:10821 FALLOW TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-2081
Practice Address - Country:US
Practice Address - Phone:407-860-5475
Practice Address - Fax:407-672-0866
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003954900Medicaid
FL000316500Medicaid
FL004122000Medicaid
FL000316501Medicaid